'Let people perish if need be, Aadhaar must prevail'

In perspective

The recent death of a 35-year-old destitute woman while giving birth to twins at her ‘home’ in front of her six-year-old daughter at Tumkuru in Karnataka, is heart-wrenching, to say the least. She was refused care and admission in the district hospital because of her inability to produce an Aadhaar or ‘Thayi’ card. In this tragedy, what is most important now is that it is not set aside as an isolated incident by either the State or us, the citizens. The State here is not referring to Karnataka, as the incident is neither unique nor specific only to Karnataka. Several such deaths occur in various parts of our country, and the vast majority do not even make it into a newspaper. It is also not about the doctor and other staff who have been suspended for their negligence; this is hardly a case of negligence. Denial of basic care in a public hospital leading to death is a case of homicide, but not necessarily against the specific individuals involved.

It is about the failure of our sovereign socialist secular democratic republic, which promises to protect our right to life with dignity, free from discrimination and exploitation, and to fulfil its responsibilities as a welfare state through a progressive taxation policy. It is about a system where establishing the rightful ‘identity’ and ensuring that the person is ‘entitled’ takes precedence over providing immediate healthcare to a woman in labour. Such stories have been common in private hospitals, but are public hospitals not supposed to follow the principle of public service? Suppose, for a moment, that this woman was not from Tamil Nadu but a migrant from Sri Lanka or Bangladesh or a Rohingya Muslim. Even then, was it not important that she be given the requisite medical care and assistance before dealing with her legal status?

It is reasonable to wonder why a doctor who has taken an oath of ethical medical practise would regard the need for an authenticated identity as more sacred. It is about the culture and ethos of how the State operates, where removing or avoiding “wrongful inclusion” has become the supreme goal, even if that means excluding often the most deserving people from even the most basic welfare services. In that sense, this is not an isolated incident. Some of you may recall the starvation deaths in Jharkhand, which exposed such exclusions in the context of the Public Distribution System (PDS), prompting economist Jean Dreze to say, “Let people perish if necessary; Aadhaar must prevail.”

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When State institutions function with such impunity, they pave the way for private institutions, which are anyway driven by profit motives, to act irresponsibly without facing any consequences. Stories of malpractices in private hospitals, especially “corporate” hospitals, are too commonplace to even find a mention here.

Weak and opaque legal frameworks coupled with even weaker and lacklustre implementation processes make the entire system almost free from any kind of accountability to the poor. Those with no social networks or capital cannot expect or demand any basic service or entitlement. If citizens raise the issue of the State’s failure to protect their rights, the State even invokes the “duties” of a citizen in order to build a nationalist state.

There are conversations going around about making the laws more stringent for public hospitals. However, what becomes critical to point out is that it is not only about the law and rules alone; it is also about the messages that those at the helm of affairs receive from everyone who matters: the higher bureaucracy, the ruling political class, and society as a whole. ‘What is valued’ is what matters, and if authentication is more valued than life, then that is what takes precedence. Those who denied hospital admission to Kasthuri, the woman who lost her life in Tumkuru, viewed the need for identity and entitlement proof as more important than saving her life, perhaps because they believed that if they admitted the woman without authentication, they would have faced an inquiry by senior authorities! There is a need to understand why they acted in the manner they did, rather than just making them the scapegoat. Is there a clear guideline for immediate medical attention without any paperwork in the case of serious patients or not?

Unless the entire system develops an ethos where protecting the rights of the most vulnerable is at the core of the welfare state, no amount of suspensions and dismissals will change anything on the ground; many more Kasthuris will die in obscurity.

(The writer heads the Centre for Budget and Policy Studies, Bengaluru)